Provider Demographics
NPI:1992816656
Name:LUTHRA, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST STE 265
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-733-1177
Mailing Address - Fax:413-733-0425
Practice Address - Street 1:300 STAFFORD ST STE 265
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-733-1177
Practice Address - Fax:413-733-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1022680OtherTUFTS HEALTH PLAN
MA3194078Medicaid
000000020422OtherBMC HEALTHNET
045414OtherCONNECTICARE
MAE05813OtherBLUE CROSS BLUE SHIELD
000000020422OtherBMC HEALTHNET
045414OtherCONNECTICARE